- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,073.30 / $16,273.90 / $25,125.50
| Facility | | $11,073.30 | $16,273.90 | $25,125.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,869.26 / $22,869.26 / $22,869.26
| Facility | | $22,869.26 | $22,869.26 | $22,869.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,833.68 / $29,618.21 / $37,972.06
| Facility | | $20,833.68 | $29,618.21 | $37,972.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,462.63 / $24,095.32 / $30,476.22
| Facility | | $12,462.63 | $24,095.32 | $30,476.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,073.30 / $16,645.30 / $26,616.60
| Facility | | $11,073.30 | $16,645.30 | $26,616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,950.12 / $22,144.86 / $33,644.48
| Facility | | $12,950.12 | $22,144.86 | $33,644.48 |